What are the treatment options for Hodgkin's Lymphoma (Hodgkin lymphoma)?

From the Guidelines

The treatment of Hodgkin lymphoma typically involves chemotherapy, radiation therapy, or a combination of both, depending on the disease stage and patient factors. For early-stage Hodgkin lymphoma (stages I-II), the standard approach is 2-4 cycles of ABVD chemotherapy (Adriamycin/doxorubicin, Bleomycin, Vinblastine, and Dacarbazine) followed by involved-field radiation therapy, as supported by studies such as 1.

Treatment Options

• For early-stage Hodgkin lymphoma, 2-4 cycles of ABVD followed by involved-field radiation therapy is the standard approach.
• For advanced disease (stages III-IV), 6 cycles of ABVD is commonly used, with alternative regimens including escalated BEACOPP (Bleomycin, Etoposide, Adriamycin, Cyclophosphamide, Oncovin/vincristine, Procarbazine, and Prednisone) which may offer better disease control but with increased toxicity, as noted in 1.
• Treatment response is typically assessed after 2-4 cycles using PET/CT imaging, which guides subsequent therapy decisions, as discussed in 1.
• For relapsed or refractory disease, salvage chemotherapy followed by autologous stem cell transplantation is often recommended, with newer targeted therapies like brentuximab vedotin and immune checkpoint inhibitors showing efficacy in relapsed cases, as mentioned in 1 and 1.
• The German Hodgkin Study Group considers eight cycles of BEACOPP escalated standard for patients <60 years, while six to eight cycles of ABVD should be used in elderly patients due to higher toxicity, as stated in 1.

Considerations

• Treatment selection considers disease characteristics, patient age, comorbidities, and potential long-term toxicities, as Hodgkin lymphoma has excellent cure rates, particularly in younger patients, making long-term quality of life an important consideration.
• The use of PET to identify those patients who require additional radiotherapy for residual tumors is currently being investigated, as noted in 1 and 1.

From the FDA Drug Label

ADCETRIS is a CD30-directed antibody and microtubule inhibitor conjugate indicated for treatment of: • Adult patients with previously untreated Stage III or IV classical Hodgkin lymphoma (cHL), in combination with doxorubicin, vinblastine, and dacarbazine (1. 1). • Pediatric patients 2 years and older with previously untreated high risk classical Hodgkin lymphoma (cHL), in combination with doxorubicin, vincristine, etoposide, prednisone, and cyclophosphamide (1.2). • Adult patients with classical Hodgkin lymphoma (cHL) at high risk of relapse or progression as post-autologous hematopoietic stem cell transplantation (auto-HSCT) consolidation (1. 3). • Adult patients with classical Hodgkin lymphoma (cHL) after failure of auto-HSCT or after failure of at least two prior multi-agent chemotherapy regimens in patients who are not auto-HSCT candidates (1. 4).

The treatment options for Hodgkin's Lymphoma (Hodgkin lymphoma) include:

• Combination therapy: Brentuximab vedotin in combination with doxorubicin, vinblastine, and dacarbazine for adult patients with previously untreated Stage III or IV classical Hodgkin lymphoma.
• Combination therapy: Brentuximab vedotin in combination with doxorubicin, vincristine, etoposide, prednisone, and cyclophosphamide for pediatric patients 2 years and older with previously untreated high risk classical Hodgkin lymphoma.
• Consolidation therapy: Brentuximab vedotin as post-autologous hematopoietic stem cell transplantation (auto-HSCT) consolidation for adult patients with classical Hodgkin lymphoma at high risk of relapse or progression.
• Salvage therapy: Brentuximab vedotin for adult patients with classical Hodgkin lymphoma after failure of auto-HSCT or after failure of at least two prior multi-agent chemotherapy regimens 2.

From the Research

Treatment Options for Hodgkin's Lymphoma

The treatment options for Hodgkin's Lymphoma (HL) include:

• Chemotherapy: The most common chemotherapy regimen used is ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) 3, 4, 5
• Radiation therapy: This is often used in combination with chemotherapy, particularly for early-stage HL 3, 6
• Combined modality treatment: This approach combines chemotherapy and radiation therapy to achieve high cure rates while minimizing risks 3, 6

Chemotherapy Regimens

The following chemotherapy regimens have been studied:

• ABVD: This is the most commonly used regimen, and it has been shown to be effective in achieving high cure rates 3, 4, 5
• ABVD-like modifications: These have also been used, with similar effectiveness to ABVD 4

Radiation Therapy

Radiation therapy is often used in combination with chemotherapy, particularly for early-stage HL. The use of low-dose radiation therapy has been shown to reduce the risk of second cancers and cardiac disease 3

Treatment Outcomes

The treatment outcomes for HL are generally favorable, with high cure rates achievable with combined modality treatment 3, 5, 6. The 7-year overall survival and progression-free survival rates have been reported to be 96% and 84%, respectively, in one study 5

Comparison of Chemotherapy Alone and Chemotherapy Plus Radiotherapy

A systematic review compared the effects of chemotherapy alone and chemotherapy plus radiotherapy in adults with early-stage HL 7. The review found that:

• The addition of radiotherapy to chemotherapy has probably little or no difference on overall survival (OS)
• The use of chemotherapy and radiotherapy improved progression-free survival (PFS) compared to chemotherapy alone
• There is no evidence for a difference between the use of chemotherapy alone and chemotherapy plus radiotherapy regarding infection-related mortality, second cancer-related mortality, and cardiac disease-related mortality